# BLUE RIDGE FAMILY MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669178430
- **Authorized official:** KIIMBERLY LACY DO (PHYSICIAN)
- **Authorized official phone:** (276) 686-4007

## Contact information

- **Practice address:** 445 GIENOW RD, RURAL RETREAT, VA 24368-3210
- **Practice address phone:** (276) 686-4007
- **Mailing address:** 306 S MAIN ST, RURAL RETREAT, VA 24368-3269
- **Mailing address phone:** (276) 686-4007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/03/2023
- **Last updated:** 10/14/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 30017597520001 | — | VA |